Changes in the response of hibernated myocardium to inotropic stimulation after angioplasty: a Doppler myocardial imaging study

BACKGROUND: Angioplasty of an infarct related artery (IRA) performed several weeks or months after myocardial infarction (MI) may improve myocardial function. HYPOTHESIS: We hypothesized that, as Doppler myocardial imaging (DMI) allows for the quantitative assessment of the systolic movement of myocardial segments, it may be a sensitive method for assessing changes in regional myocardial contraction and contractile reserve pre and post angioplasty of the IRA. METHODS: In all, 39 patients (30 men, mean age 53.4 +/- 8.3 years), 1 to 6 months after MI, who qualified for IRA angioplasty on the basis of myocardial viability in the infarcted zone as demonstrated by dobutamine stress echocardiography, were included in the study. Peak regional myocardial systolic velocities (S wave) of the infarcted segments were measured at rest and during low-dose dobutamine infusion (15 microg/kg/min) 1 day before angioplasty (Exam 1), 2 to 5 days (Exam 2), and 30 days (Exam 3) after successful angioplasty. The long-axis movement of the mitral annulus and of the basal and medial segments of the posterior (20 patients), anterior (17 patients), and lateral walls (2 patients) was evaluated. RESULTS: At rest, S-wave velocity of the infarcted segments increased between Exams 1 and 2, without further improvement between Exams 2 and 3 (4.9 +/- 1.2 vs. 5.6 +/- 1.3 cm/s, p < 0.05 and 5.6 +/- 1.3 vs. 5.5 +/- 1.3 cm/s, NS, respectively). However, S-wave velocities measured during low-dose dobutamine infusion differed significantly both between Exams 1 and 2, and 2 and 3 (7.0 +/- 1.5 vs. 7.8 +/- 1.8 cm/s; p < 0.01; 7.8 +/- 1.8 vs. 8.5 +/- 1.6 cm/s; p < 0.05). CONCLUSIONS: Resting contractility at an infarct zone demonstrated rapid initial improvement after angioplasty of the IRA with no further change, whereas contractile reserve improved not only immediately after angioplasty but also during the next month.     

Effect of dynamic myocardial dyssynchrony on mitral regurgitation during supine bicycle exercise stress echocardiography in patients with idiopathic dilated cardiomyopathy and 'narrow' QRS.

AIMS: Cardiac resynchronization therapy (CRT) has become an attractive therapeutic option for patients with end-stage heart failure (HF). Currently, patients are selected for CRT on ECG and on echocardiographic criteria analysed at rest. Whether the physical effort may further increase myocardial dyssynchrony is not fully established. The aim of the study was to test by the use of Doppler myocardial imaging (DMI) if dynamic left ventricular (LV) dyssynchrony during physical effort may be a determinant of dynamic mitral regurgitation in patients with dilated cardiomyopathy and 'narrow' QRS. METHODS AND RESULTS: Sixty patients (62.3 +/- 8.3 years) with idiopathic dilated cardiomyopathy and narrow QRS duration ( < 120 ms) were selected. All the patients underwent standard Doppler echo, colour DMI, supine bicycle exercise stress echocardiography, and cardiopulmonary exercise testing. Cardiac synchronicity was assessed, at rest and at peak exercise, from measurements of time intervals (Ts) between the onset of the QRS complex and the peak myocardial systolic velocity, in a six-basal-six-mid-segmental model. Standard deviation of Ts of the 12 LV segments (Ts-SD-12) was also calculated. In baseline conditions, HF patients showed an LV ejection fraction of 30.1 +/- 4%, and a significant electromechanical delay (Ts-SD-12 > or = 34.4 ms) in 20 patients (33.3%). At peak of physical exercise, a significant electromechanical delay was detected in 35 patients (58.3%), whereas in 47 patients (78.3%) exercise-induced increase in mitral valve effective regurgitant orifice (ERO) was observed. By multivariable analysis, an independent positive association between changes in Ts-SD-12 and in mitral valve ERO (P < 0.0001), as well as an independent inverse correlation of the same changes in Ts-SD-12 with LV stroke volume (P < 0.0001) were detected. In addition, changes in Ts-SD-12 were also independent determinants of peak VO(2) (P < 0.0001) during cardiopulmonary exercise testing. CONCLUSION: Colour DMI is an effective technique for assessing the severity of regional delay in activation of LV walls in HF patients with narrow QRS both at rest and during stress test. The increase in LV dyssynchrony during exercise strongly correlates with the increase in mitral regurgitation severity and with the impairment of LV stroke volume.     

多普勒组织成像技术在心肌梗死心功能评价中的应用

目的:研究多普勒组织成像(DTI)技术评价心肌梗死的临床应用价值。方法:回顾性分析应用DTI及彩色多普勒超声心动图(UCG)检查30例急性心肌梗死(AMI)患者的资料。结果:①AMI后2周,3个月,6个月时左室舒张功能显著减退(P<0.01),而左室收缩功能在2周时显著降低(P<0.01),随时间的推移略有改善;②AMI患者DTI速度图显像能更直观反应梗死相关局部的心肌室壁病变;③AMI患者2周时DTI频谱图特征:收缩波,舒张早期波E波和E／A(舒张晚期波)振幅比值降低(P均<0.01)。结论:DTI技术为观察AMI后心肌的室壁运动,心脏的收缩和舒张功能提供了一个直观,而且重复性好的有效方法。     

Prognostic value of pulsed tissue Doppler imaging for the assessment of left ventricular systolic function in patients with nonischemic dilated cardiomyopathy

There is still some debate regarding the prognostic significance of left ventricular longitudinal systolic dysfunction as assessed by tissue Doppler (TD) imaging in patients with chronic heart failure (HF), since previous studies have included patients with postischemic wall motion abnormalities. Thus, this study was designed to ascertain whether TD-derived longitudinal systolic dysfunction may influence the outcome of patients with nonischemic chronic HF. In 200 consecutive patients with chronic HF secondary to dilated cardiomyopathy and no history of ischemic heart disease, peak systolic mitral annular velocity (S(m) ) was measured by pulsed TD at the septal and lateral annular sites. The end points were cardiac death or hospitalization for worsening HF. Mean follow-up duration was 30 months. In a time independent analysis, averaged S(m) calculated as the average of septal and lateral S(m) , resulted to be a significant predictor of outcome in the study population (area under receiver-operator characteristic curve: cardiovascular death, 0.69, P < 0.0001; cardiovascular events, 0.64, P = 0.0005). In a time-dependent analysis, average S(m) was associated with both cardiovascular death (hazard ratio 0.832, P = 0.0019) and cardiovascular events (hazard ratio 0.904, P = 0.039), independently of other clinical risk factors and echocardiographic parameters of systolic function. Septal S(m) but not lateral S(m) was independently associated with the outcome measures. In conclusion, the assessment of systolic mitral annular velocity by pulsed TD is a useful indicator for prognostic stratification of patients with nonischemic dilated cardiomyopathy and chronic HF.     

Striking effect of left ventricular high filling pressure with mitral regurgitation on mitral annular velocity during early diastole. A study using colour M-mode tissue Doppler imaging.

AIMS: To evaluate the effect of considerably high left ventricular filling pressure with mitral regurgitation on mitral annular velocity during early diastole. SUBJECTS: Two hundred and forty-three patients who underwent cardiac catheterization for evaluation of chest pain. METHODS: Mitral annular velocity during early diastole was measured by colour M-mode tissue Doppler imaging. Patients were divided into the following three groups according to the cardiac catheterization data. Group A (n=147): patients having left ventricular relaxation time constant tau<46 ms and left ventricular end-systolic volume index <38 ml m(-2); group B (n=88): patients having tau>or=46 ms and/or end-systolic volume index >or=38 ml m(-2); group C (n=8): patients having mean pulmonary capillary wedge pressure >or=16 mmHg in addition to tau>or=46 ms and end-systolic volume index >or=38 ml m(-2). RESULTS: Mitral annular velocity during early diastole was significantly less in group B (4.8+/-1.4 cm s(-1)) than in group A (7.7+/-1.9 cm s(-1)). However, there was no significant difference between groups A and C (8.3+/-0.8 cm s(-1)). A transmitral E/A >1.0 was observed in 12/147 patients of group A, 10/88 of group B, and 8/8 of group C. The incidence of >or=Sellers' grade II mitral regurgitation was higher in group C than the others. CONCLUSIONS: A paradoxically faster mitral annular velocity during early diastole is found in patients having left ventricular dysfunction with moderate to severe mitral regurgitation and considerably high left ventricular filling pressure. Attention should be paid to an interpretation of mitral annular velocity during early diastole regarding left ventricular early diastolic performance in patients having mitral regurgitation with an E/A >1.0 in their transmitral flow.     

Noninvasive assessment of left ventricular end-diastolic pressure with tissue Doppler imaging in patients with mitral regurgitation

Background: The ratio of early transmitral flow velocity to mitral annulus early diastolic velocity (E/Ea) is a widely used noninvasive tool to estimate left ventricular end diastolic pressure (LVEDP). The aim of this study was to explore whether E/Ea ratio was a reliable index for the estimation of LVEDP in patients with mitral regurgitation (MR). Methods: Sixteen patients with nonischemic MR (primary MR group; 6 male, 58 ± 12 years) 51 patients with ischemic MR (secondary MR group; 29 male, 63 ± 9 years) and 29 patients without MR (control group; 19 male, 53 ± 10 years) were consecutively included. The peak transmitral flow and mitral annular velocities during early diastole were measured. LVEDP was determined invasively by left heart catheterization. Results: Primary and secondary MR groups had significantly higher E/Ea ratios and LVEDP than control group. LVEDP significantly correlated with E/Ea ratio in patients with primary MR, but not in patients with secondary MR. Multiple regression analysis revealed that E/Ea ratio was an independent predictor of LVEDP in patients with primary MR. Ten patients with primary MR had LVEDP ≥15 mmHg. ROC analysis demonstrated cutoff values for E/Ea ratios as >10.5 for lateral mitral annulus (sensitivity: 80%, specificity: 66%, PPV: 80%, NPV: 66%) and as >14 for medial mitral annulus (sensitivity: 90%, specificity: 83%, PPV: 90%, NPV: 83%) to predict primary MR patients with LVEDP ≥15 mmHg. Conclusion: E/Ea ratio is still reliable in estimation of LVEDP in primary MR patients while it is not predictive for LVEDP in secondary MR patients. (Echocardiography 2011;28:633‐640)     

Prognostic value of tissue Doppler echocardiographic imaging in elderly patients with acute myocardial infarction

Background: The ratio of mitral end‐diastolic velocity and mitral annular early diastolic motion velocity (E/e’) has predictive value in patients with acute coronary syndromes (ACS). Both E and e’ velocities change with age. The prognostic value of E/e’ in elderly patients with ACS has not been established yet. The aim of the study was to assess the prognostic significance of E/e’ in patients over 65 with ACS. Method: The study involved 168 patients, mean age 79 years. Echocardiography was performed within first 24 hours of ACS. Clinical evaluation, 6‐minute walk test, echocardiography and plasma level of NT pro‐BNP were performed 12 months later. Results: Patients, who were still alive after 1‐year follow‐up had significantly lower E/e’ during hospitalization: 11.1 ± 3 versus 15.1 ± 5 (P < 0.05). The optimal cutoff value of E/e’ differentiating survivors and nonsurvivors after 12 month follow‐up was 12. Initial E/e’ was an independent predictor of mortality during 1‐year follow‐up. E/e’ ratio during hospitalization significantly correlated with NT pro‐BNP concentration (r = 0.48, P < 0.001) and 6‐minute walking distance: (r =–0.32, P < 0.05) after 1‐year follow‐up. Conclusions: (1) In patients over 65 with myocardial infarction, E/e’ above 12 is an independent predictor of death during 1‐year follow‐up. (2) E/e’ ratio in acute phase of myocardial infarction correlated significantly with N pro‐BNP level and 6‐minute walking distance after 1‐year follow‐up. (Echocardiography 2011;28:298‐302)     

Improvement in diastolic left ventricular function after coronary artery bypass grafting as assessed by recordings of mitral annular velocity using Doppler tissue imaging.

AIMS: The aim of the study was to evaluate the changes in diastolic function after coronary artery bypass grafting (CABG), using pulsed-wave Doppler tissue imaging (DTI). METHODS: Fifty-three patients with coronary artery disease were studied before and 3 and 12 months after CABG. Using pulsed-wave DTI, the mitral annular velocities were determined at 4 sites in the left ventricle (LV). Patients were also examined with dobutamine stress echocardiography and myocardial scintigraphy before and 3 months after CABG. RESULTS: The conventional transmitral velocity profiles were unchanged after CABG. DTI showed a marked improvement in diastolic LV function after CABG (early diastolic velocity: 7.5+/-1.9, 8.2+/-1.7 and 9.3+/-2.7 cm/s before and 3 and 12 months after CABG, respectively, P < 0.01). The improvement in early diastolic velocity was more pronounced in patients showing no sign of residual ischemia in comparison to those with residual ischemia determined by myocardial scintigraphy (7.41+/-2.04 vs. 9.25+/-2.61 cm/s, P < 0.01 in the nonischemic group; 7.29+/-2.16 vs. 8.41+/-2.55 cm/s, n.s., in the ischemic group). Before CABG, a significant increase in the systolic velocity (6.4+/-1.3 vs. 8.7+/-2.5 cm/s, P < 0.001), but not the early diastolic velocity (7.6+/-1.9 vs. 8.0+/-2.2 cm/s), was noted during stress echocardiography. Three months after CABG, both the systolic (6.5+/-1.3 vs. 9.3+/-2.8 cm/s, P < 0.001) and the early diastolic velocities (8.1+/-1.8 vs. 10.3+/-2.2 cm/s, P < 0.001) improved during stress echocardiography. CONCLUSION: The results of the present study show that diastolic function improves at rest and under stress in patients after CABG. The improvement was seen only in patients without postoperative signs of reversible ischemia.     

Mitral inflow and mitral annular motion velocities in patients with mitral annular calcification: evaluation by pulsed Doppler echocardiography and pulsed Doppler tissue imaging.

AIMS: We evaluated the relationship between the mitral inflow velocities by pulsed Doppler echocardiography and mitral annular motion velocities by pulsed Doppler tissue imaging in patients with mitral annular calcification.METHODS AND RESULTS: Fifty-three patients with mitral annular calcification were divided into two groups: severe mitral annular calcification (n=15, mitral annular calcification bigger than or equal 5mm in width) and mild mitral annular calcification (n=38, mitral annular calcification <5mm in width). In addition, 20 patients with hypertensive heart disease (HHD group) and mild left ventricular hypertrophy but no mitral annular calcification and 30 normal individuals (normal group) were studied. The early diastolic mitral inflow velocity (E) was higher in the severe mitral annular calcification group (0.75+/-0.26 m/s) than in the HHD and normal groups (mild mitral annular calcification, 0.65+/-0.21; HHD, 0.57+/-0.24; normal, 0.55+/-0.15m/s), and the late diastolic mitral inflow velocity (A) was higher in the severe mitral annular calcification group (1.24+/-0.23 m/s) than in the other three groups (mild mitral annular calcification, 0.96+/-0.20; HHD, 0.84+/-0.23; normal, 0.75+/-0.13 m/s). In contrast, the early and late diastolic annular velocities (Ea, Aa) were lower in the severe mitral annular calcification group (Ea: 5.7+/-2.2; Aa: 11.9+/-4.4 cm/s) than in the other three groups (Ea: mild mitral annular calcification, 8.3+/-2.5; HHD, 7.7+/-2.2; normal, 9.0+/-1.8 cm/s; Aa: mild mitral annular calcification, 14.2+/-4.1; HHD, 14.3+/-2.8; normal, 14.2+/-2.1cm/s). Mitral valve area was smaller in the severe mitral annular calcification group (2.6+/-1.0 cm(2)) than in the other three groups (mild mitral annular calcification, 3.1+/-0.7; HHD, 4.1+/-0.7; normal, 4.2+/-0.9 cm(2)). In the mitral annular calcification and normal groups, the A correlated inversely with mitral valve area (r=-0.67, P<0.01) and directly with severity of mitral annular calcification (r=0.65, P<0.01), and the Ea correlated inversely with left ventricular wall thickness (r=-0.37, P<0.01) and severity of mitral annular calcification (r=-0.45, P<0.01).CONCLUSION: Patients with severe mitral annular calcification have higher mitral inflow velocities due to mitral annular restriction and lower mitral annular velocities caused by decreased mitral annular motion and abnormal left ventricular relaxation.     

组织多普勒技术评估血栓抽吸治疗对急性下壁心肌梗死患者右室功能的影响

目的 探讨组织多普勒(TDI)技术评估血栓抽吸治疗对急性下壁心肌梗死(AIMI)患者右室功能的影响.方法 将46例AIMI患者随机分为两组,对照组27例行急诊经皮冠脉介入(PCI)治疗,观察组19例行PCI+血栓抽吸治疗.两组均于PCI后1周行超声心动图检查,在胸骨旁长轴用M型超声检测左室舒张末内径(LVEDD)、左房前后径(LAD)、右室舒张末内径(RVEDD)、左室射血分数(LVEF);在标准心尖四腔心切面转换为TDI频谱多普勒形式,检测三尖瓣环收缩期峰值运动速度(Sm)、舒张早期峰值运动速度(Em)、心房收缩期峰值运动速度(Am)及Em/Am比值;并计算右室Tei指数.结果 与对照组比较,观察组三尖瓣环的Sm、Em、Am及Em/Am比值升高,右室Tei指数下降(P均＜0.05),LVEDD、LAD、RVEDD、LVEF均无明显变化(P均＞0.05).结论 TDI技术能检测到AIMI患者的右室功能变化,血栓抽吸治疗可改善其右室功能.     

Assessment of myocardial velocities and global function of the left ventricle in asymptomatic patients with moderate-to-severe chronic aortic regurgitation: a tissue Doppler echocardiographic study

OBJECTIVE: Asymptomatic patients with chronic aortic regurgitation (AR) have an excellent prognosis in the presence of preserved systolic function. It is a challenge to recognize patients with subclinical myocardial dysfunction in AR. Conventional parameters still have many drawbacks in predicting early left ventricular (LV) dysfunction. Pulsed-wave tissue Doppler imaging (PW-TDI) is a useful noninvasive technique for evaluating global and regional LV systolic function. In this study, we aimed to assess clinical usefulness of TDI in predicting early disturbance of myocardial contractility in asymptomatic patients with significant AR and preserved left ventricular systolic function. METHODS AND THE RESULTS: Echocardiograms were obtained in 32 AR patients and 33 healthy subjects. In addition to conventional parameters, regional myocardial velocities, isovolumetric contraction time (mICT), isovolumetric relaxation time (mIRT), and ejection time (mET) of left ventricle were obtained by TDI and modified LV myocardial performance index (MPI) was calculated. In AR, peak systolic velocity (Sm) of septal and anterior mitral annulus, and mean Sm was significantly lower, and LVMPI was significantly higher compared to control group. CONCLUSION: The data obtained by TDI show that LV MPI is lengthened, and systolic myocardial velocities are shortened in patients having chronic AR with normal LV systolic function according to conventional echocardiographic parameters. This suggests that LV long-axis contraction and global LV performance are preciously and noticeably decreased in patients with moderate-to-severe chronic AR despite normal LV ejection fraction.     

Impact of left ventricular diastolic function on exercise capacity in patients with chronic mitral regurgitation: an exercise echocardiography study

BACKGROUND: Mitral regurgitation (MR) is known as one of the most frequent causes of heart failure and sudden death. In spite of increasing prevalence of MR, there have been no available data on cardiac determinants of exercise capacity in patients with chronic MR. HYPOTHESIS: This study aimed to investigate cardiac determinants of exercise capacity in patients with chronic MR. METHODS: We consecutively enrolled 32 patients (11 men, mean age: 44 +/- 14 years) who had greater than moderate MR with normal left ventricular (LV) systolic function (LV ejection fraction >50%). Conventional echocardiographic indices and parameters measured by Doppler tissue imaging at septal side of mitral annulus were obtained before exercise. Mitral regurgitation fraction, forward stroke volume, pulmonary venous flow velocities, and systolic pulmonary artery pressure (sPAP) were also obtained with standard methods. RESULTS: Left ventricular ejection fraction was 61 +/- 6% and MR fraction was 48 +/- 13%. All patients finished a symptom-limited treadmill exercise test with a peak heart rate of >85% of predicted maximum heart rate. Mean exercise time was 9.95 +/- 2.17 min, corresponding to 11 +/- 2 metabolic equivalents. Among pre-exercise echocardiographic variables, only early diastolic mitral annulus velocity (E') and pulmonary venous reversal flow velocity (PVa) showed a significant correlation with exercise time (r = 0.44, p = 0.011, and r = -0.40, p = 0.040, respectively), which persisted after multivariate analysis (p = 0.011 and 0.038, respectively). Other parameters such as systolic mitral annulus velocity, resting and postexercise sPAP, forward stroke volume, LV size, LV ejection fraction, left atrial size, and regurgitant fraction showed no significant correlation. CONCLUSIONS: Left ventricular diastolic function is an important determinant of exercise capacity in patients with chronic MR. Both E' and PVa, accepted surrogate estimates for LV diastolic function, may be useful for identifying patients with chronic MR and with poor exercise capacity.     

用多普勒组织显像速度模式评价左心室收缩及舒张功能

目的 :初步评价多普勒组织显像 （DTI）检查左心室收缩和舒张功能的临床应用价值。方法 :用 DTI速度模式检测了正常健康组 114例和左室收缩功能降低 （左室缩短率 FS<2 5 % ）组 40例二尖瓣后叶瓣环位及左室后壁心肌的运动速度。结果 :各参数在正常男女间无显著差异 ,心功能降低组较正常组明显降低 （P<0 .0 1） ;正常组左室后壁心肌收缩速度与 FS间呈正相关 （r=0 .38）。结论 :用 DTI的速度模式检测局部室壁运动速度是评价心室收缩和舒张功能的一种较简便、直观、全面、准确的新方法     

Detection of abnormal left ventricular function by Doppler tissue imaging in patients with a first myocardial infarction and showing normal function assessed by conventional echocardiography.

AIMS: The aim of the study was to characterize left ventricular (LV) function by Doppler tissue imaging (DTI) after a first myocardial infarction (MI) where the conventional echo-Doppler parameters showed no abnormalities. METHODS: Out of 202 patients who were referred for an echocardiogram, 19 patients were previously healthy and had a normal ejection fraction and no wall motion abnormalities at echocardiogram. These 19 patients were compared with 16 age-matched healthy subjects (HS). The longitudinal LV function was assessed using the mitral annular velocities (mean value from four different sites of the LV) determined by DTI. RESULTS: The patients with MI had significantly reduced peak systolic and peak early diastolic mitral annular velocities compared to HS (8.6 v. 9.7 cm/s, P<0.001 for systolic velocity, and 10.9 v. 12.3 cm/s, P<0.01 for diastolic velocity, respectively). The patients had normal diastolic LV function assessed by the conventional Doppler echocardiogram (e.g. transmitral flow, IVRT and pulmonary venous flow patterns). To assess the LV filling pressure, the ratio of the transmitral early wave velocity assessed by conventional echo-Doppler and peak early diastolic mitral annular velocity determined by DTI (E/Edti) was used. The E/Edti was significantly higher in patients than in HS (7.0 v. 5.7, P<0.05). CONCLUSION: Previously healthy subjects who are suffering from a first MI and showing normal systolic and diastolic LV function, determined by conventional echo-Doppler methods, show decreased mitral annular systolic and diastolic velocities determined by DTI compared to healthy subjects. This is probably evidence of mild subendocardial damage due to MI that remains undetected by conventional echo-Doppler methods.     

Assessment of left ventricular myocardial performance by tissue Doppler echocardiography in patients with polycythemia vera

Aims: The aim of this study was to evaluate myocardial performance index (MPI) which reflects the combined systolic and diastolic performance of the ventricles by tissue Doppler imaging (TDI) in patients with polycythemia vera (PV). Method and Materials: Twenty‐eight patients with PV (17 men; mean age 60 ± 9 years) and 30 age‐matched healthy subjects were prospectively evaluated. The diagnosis of PV was performed according to the World Health Organization (WHO) criteria. Left ventricular (LV) systolic and diastolic functions were assessed by conventional echocardiography and TDI. MPI of both the LV and right ventricles (RV) were measured by TDI method. Results: The LV MPI was significantly higher in PV group than in the controls (0.61 ± 0.16 vs. 0.49 ± 0.05; P = 0.001). Also, the RV MPI was impaired in patients with PV compared to the control subjects (0.51 ± 0.11 vs. 0.43 ± 0.09; P = 0.005). RV late A filling velocity (Am) and RV isovolumetric relaxation time were significantly higher in the PV group compared to healthy subjects (P = 0.03 and 0.05, respectively). In logistic regression models, PV was determined as an independent predictor of impaired MPI (odds ratio: 3.7; CI 95%, 1.2–7.5). In addition, pulmonary arterial pressure was significantly elevated in patients with PV compared to the controls (P = 0.02). Conclusion: This study demonstrated that biventricular MPI is impaired in patients with PV. (Echocardiography 2011;28:948‐954)     

多普勒组织成像技术评价血运重建对急性心肌梗死患者心功能的影响

目的 应用多普勒组织成像(DTI)评价血运重建对急性心肌梗死(AMI)患者心功能的影响.方法 对65例AMl患者分别予以常规强化内科保守治疗(常规治疗组,20例)和在此基础上的血运重建治疗(血运重建组,45例).应用二维超声心动图和DTI分别观察两组AMI后1周、3个月及6个月的左室射血分数(LVEF)、二尖瓣血流舒张早期流速与心房收缩期流速的比值(VE/VA)、二尖瓣环6个位点节段的二尖瓣环收缩期运动速度峰值(Sa)、舒张早期运动速度峰值(Ea)和舒张晚期运动速度峰值(Aa).20名健康人为对照组.结果 常规治疗组和血运重建组各时点亚组的LVEF、VE/VA、Sa和Ea及常规治疗组3个月和6个月亚组的Ea/Aa均小于对照组(P<0.05),血运重建组3个月、6个月亚组的Sa、Ea和6个月亚组的LVEF较常规治疗组显著升高(P<0.05),而两组同时点各亚组间的VE/VA、Aa及Ea/Aa比较,差异无统计学意义(P>0.05).结论 血运重建是改善AMI后左室收缩、舒张功能的重要手段.DTI技术在评价AMI后心脏整体收缩、舒张功能变化方面较二维超声心动图更为敏感.     

多普勒组织成像技术评价急性心肌梗死右心室功能

急性心肌梗死 ( A MI)中右心室发生了一系列病理生理变化。右心室功能对于 A MI的发展及预后有重要意义 ,而右心室功能的评价较为复杂 ,多普勒组织成像 ( DTI)技术的应用为评价右心室功能提供了一种可靠的方法     

Regional atrial myocardial velocity in normal fetuses: evaluation by quantitative tissue velocity imaging

Objectives: Quantitative tissue velocity imaging (QTVI) is a new noninvasive method that derives measurements of velocities directly from the myocardium. Data on atrial myocardial tissue velocities in normal fetuses have not been established. The objective of this study was to evaluate atrial myocardial velocity and the myocardial velocity gradient of normal fetuses by using QTVI. Methods: We measured motion velocities of the left and right atrial wall along the long axis in 50 normal fetuses aged 21–32 weeks gestation (mean, 25.3 ± 2.8 weeks). In all fetuses, peak myocardial velocity during early diastole (EW), atrial contraction (AW), and ventricular systole (SW) waves was recorded in the basal and mid‐atrial segments. Correlation analysis was conducted between segmental velocities of the left atrium (LA) and right atrium (RA) and gestational age. Results: The mean values for EW, AW, and SW of the long axis in the same right basal segment of the RA were greater than those of the LA (P < 0.01). There was a degressive gradient with velocity from the basal to superior in the atrial wall. There was a linear relationship with gestation for all basal myocardial velocities of the left and right atrial free wall (P < 0.05). However, the myocardial velocity variables of the midatrial wall showed no age‐dependence. Conclusion: We demonstrated that QTVI is reproducible and provides readily obtained parameters that provide unique data regarding segmental atrial myocardial velocity in normal fetuses. (Echocardiography 2012;29:182‐186)     

Pulmonary hypertension and left heart function: insights from tissue Doppler imaging and myocardial performance index

BACKGROUND: As a consequence of a leftward shift of the interventricular septum and of pericardial restraint, related to the degree RV dilatation, left heart function would be influenced after pulmonary hypertension and right heart failure. METHODS AND RESULTS: We enrolled 70 patients with pulmonary artery systolic pressure (PASP) more than 30 mmHg: 40 patients with PASP between 30 and 60 mmHg (Group 2), 30 patients with PASP more than 60 mmHg (Group 3). Another 70 patients with normal heart performance and PASP less than 30 mmHg served as the control group (Group 1). Myocardial performance index (MPI), isovolumic contraction time (IVCT), and isovolumic relaxation time (IVRT) were obtained by tissue Doppler imaging (TDI). PASP correlated negatively to peak systolic velocity of lateral tricuspid annulus (RV-Sm) and RVEF. The MPI of RV and LV in patients with severe pulmonary hypertension (Group 3) became higher as the result of the prolongation of IVRT. The higher E/Em (peak early-diastolic mitral-inflow velocity divided by early-diastolic velocity of mitral annulus) in pulmonary hypertension indicated diastolic dysfunction of LV. The decline of left ventricular ejection fraction, and also right ventricular ejection fraction, suggested LV systolic dysfunction after pulmonary hypertension. The LV-MPI truly reflected LV systolic and diastolic dysfunction in patients with pulmonary hypertension. In multiple linear regression analysis, LV-MPI was independently associated only with RV-MPI (Beta 0.47, P < 0.0001). CONCLUSION: The result infers that the systolic and diastolic function of LV declined, following pulmonary hypertension.